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National hand-washing campaign improved hygiene and reduced infection

4 May 2012

An evaluation of the national cleanyourhands campaign shows for the
first time that an effective hand-hygiene campaign, undertaken in the context
of a high profile political drive, can successfully reduce some healthcare
associated infections, according to a new study published in the BMJ.

The national cleanyourhands campaign was rolled out
to all 187 NHS Trusts from January 2005 with instructions to provide bed-side alcohol
handrub (AHR), posters encouraging healthcare workers to clean their hands and
a range of patient-empowering materials. It was one of a series of national
initiatives intended to reduce levels
of meticillin resistant/sensitive Staphylococcus
aureus (MRSA/MSSA) bacteraemia and Clostridium
difficile (C. difficile) infection in hospitals in England & Wales.

The evaluation of the campaign
was conducted by researchers at UCL’s Medical School and the Health Protection
Agency (HPA). They measured hospitals’ quarterly procurement of AHR and soap between
July 2004 and 2008. After adjusting for a number of factors, including the effect of bed occupancy, hospital
type and the timing of other national interventions, they
found a significant link between procurement levels and infection rates.

The research shows that during over the four-year period the
combined procurement of soap and AHR almost tripled from 21.8mls per-patient-per-bed
to 59.8mls. MRSA bacteraemia rates fell from 1.88 to 0.91 cases per 10,000
bed-days and C. difficile infection
fell from 16.75 to 9.49 per 10,000 bed-days. Levels of MSSA bacteraemia did not
fall.

The cleanyourhands campaign has been a real British success story. It has really changed the culture amongst NHS staff

Dr Sheldon Stone, UCL Medical School

The
research also shows that the increased procurement of soap was independently
associated with reduced C. difficile infection throughout the study,
while increased procurement of alcohol hand rub was independently associated
with reduced MRSA infection, but only in the last year of the study. These
strong and independent associations remained after taking account of all other
interventions.

“Until
now we haven’t been able to say whether national campaigns of this kind deliver
tangible benefits for patients,” says principal investigator Dr Sheldon Stone
of the UCL Medical School. “What this study shows is that the cleanyourhands
campaign, a centrally co-ordinated and funded strategy, produced sustained
increases in the amounts of alcohol hand-rub and soap bought by hospitals, and
that this in turn helped to reduce infection and improve health outcomes.”

“The cleanyourhands campaign has been a real
British success story. It has really changed the culture amongst NHS
staff,” continues Dr Stone. “Now the campaign has stopped, many in
the infection control community would like to see the progress maintained
and built upon with a new national hand hygiene strategy or an updated
campaign."

Professor
Barry Cookson, Director of the Laboratory of Healthcare Associated Infection,
at the HPA says: “This research paper shows that relatively simple measures
such as handwashing and alcohol handrub can be exceptionally effective in
combating the spread of harmful bacteria in healthcare establishments.

"Independent of all other measures we saw that the more soap and alcohol handrub
were purchased the more levels of MRSA and C.
difficile went down. Going forward it is these types of measures
which will be at the forefront of the battle against the spread
of bacteria.”